Shortly after Jeff Graham was hired in 2008 to lead Georgia Equality, one of his new co-workers at the state's top gay advocacy group took him aside to offer a bit of friendly advice.
"We're very excited about you coming on board," Graham remembers being told, "but we hope you're not going to spend too much time talking about AIDS."
Graham, a longtime AIDS activist who'd spent most of his adult life organizing rallies, demonstrations and sit-ins to focus public attention on the epidemic, would've been more taken aback by the well-intended suggestion if he hadn't already been keenly aware of a sharp shift in the public perception of AIDS.
The killer of nearly half a million otherwise healthy Americans during the '80s and early '90s had lost much of its fearsome reputation since the development of retroviral cocktails that controlled symptoms and curbed mortality. Graham worries that the very subject of AIDS has become a turnoff, something even few gay men want to hear about these days.
"Folks are losing the message that AIDS is still a problem, even though Georgia still has one of the highest infection rates in the country," he says. "There's not a sense of urgency because we're not seeing people die as quickly as they used to."
And yet, says AID Atlanta Executive Director Tracy Elliott, people still are dying of the disease in Atlanta.
"We have clients die all the time," says Elliott, who is likewise concerned that AIDS has slipped far down the list of priorities for LGBT activists and society at large.
"This used to be the most important cause for the gay community, but now it competes with civil rights and gay marriage," he says.
When AID Atlanta was founded in 1982, there was no regimen of treatment for the mysterious new disease. Initially composed of a handful of volunteers, the grassroots group could only lend comfort to AIDS patients — many of whom had lost their jobs and been shunned by their families — helping them live out their final days in dignity.
Over time, as various drugs came on the market, AID Atlanta hired case managers to help sick clients coordinate lodging, insurance, counseling, medical treatment and other social services. Even as the number of AIDS-related deaths declined, the agency grew, adding its own testing clinic. It's now a $6.5 million nonprofit enterprise with 100 full-time employees.
"This city has a wonderful system of care," Elliott says. "People with HIV should not fall through the cracks in Atlanta."
But he's worried that younger gay men aren't getting the message that AIDS can still be deadly.
"With young people today, it's someone else's disease, something that happened to an earlier generation," Elliott says, adding that most infections today occur among black men in their late teens or early 20s.
Retired psychiatrist Jesse Teel agrees that there's a generational disconnect between the shell-shocked survivors of the epidemic and younger gay men who seem unwilling to view AIDS as a threat.
"The mind-set now is, 'If I catch it, all I have to do is take a pill,'" he says. "That's because they aren't going to funerals every week."
When Teel moved to Atlanta in the late '70s, he wanted to set up a practice that would help gay men come to terms with their sexuality.
"Be careful what you wish for," he says. "I had patients who'd lost three or four of their best friends. AIDS really galvanized the gay community. There really were no advocacy or support groups at the time, so we formed our own to care for each other. We all volunteered because you couldn't not do something."
Teel joined the board of the nascent AID Atlanta in 1984, holding fundraisers at his house. Later, he was appointed to a statewide AIDS Task Force, the main duties of which, he says, were to "bring attention to the issue and give cover to the state Department of Public Health to undertake initiatives" that weren't popular with the governor's office.
Also during those years, the Atlanta chapter of ACT UP was living up to its name with high-profile acts of protest and civil disobedience aimed at shaming politicians to support pharmaceutical research and pressure the medical establishment to allow more patients into clinical trials for new drugs.
ACT UP was a wholly volunteer organization, of which Graham was a prominent member, meeting every week with 20 to 30 fellow volunteers for the better part of a decade to organize an average of a half-dozen demonstrations every month. Graham later became director of AIDS Survival Project, another grassroots organization that advocated for anti-discriminatory public policies and helped AIDS patients get access to medical care. That organization closed its doors in 2008.
But Elliott and the others concede that the public perception about AIDS didn't really change until a decade into the epidemic, after Ryan White, Magic Johnson and other well-publicized cases showed that the virus didn't just strike gay people.
Then, in 1996, the introduction of new retroviral drugs meant that a positive HIV test was no longer a death sentence. In the intervening years, AIDS has gone from being the nation's foremost public health crisis to being popularly viewed as a disease that kills villagers in Africa.
"AIDS is still a critical health issue for Georgia," says Graham, noting that the state DHR has been particularly poor at handling grants to private nonprofits, having returned more than $2 million in unspent federal funds since 2006 that should have gone to HIV prevention. The agency has also been criticized for a program designed to pay insurance premiums for low-income people with HIV; many patients have lost insurance because of missed payment deadlines. And, most recently, state officials are investigating $5 million in contracts for HIV testing, some of which were apparently funneled to former state employees without competitive bidding.
According to the most recent CDC statistics, Georgia still ranks fifth among states with the highest numbers of new HIV infections, behind Florida, California, New York and Texas. The CDC estimates that metro Atlanta had about 1,000 new AIDS cases in 2009, placing it neck-and-neck with Chicago.
Those numbers, combined with public indifference and government fumbling and cost-cutting, worry Graham. As the veteran AIDS activist says, "I'm very concerned that, if we don't draw more attention to the problem, we could see mortality rates rise again for a disease that's preventable and controllable."